VII. Nonparticipation in TTW

This chapter discusses the market for employment-support services from the perspective of beneficiaries who do not participate in the TTW program. Three factors likely to contribute to nonparticipation are explored. First, only 32 percent of working-age beneficiaries report having goals that include work or career advancement. Thus, most ticket-eligible beneficiaries do not appear to have concrete work goals or expectations and are therefore unlikely to demand the types of employment-support services that TTW tries to foster. This general absence of employment goals is not surprising, given that all disability beneficiaries have been subject to a rigorous eligibility determination process through which they were found unable to engage insubstantial gainful activity.

A second reason for nonparticipation is that most beneficiaries who do have employment goals were not aware of the TTW program at the time of the survey. Specifically, only about 15 percent of all Phase 1 nonparticipants were both aware of TTW and understood that it was designed to help them get training or employment services intended to improve their ability to work. This lack of awareness has limited the extent to which beneficiaries seek out TTW services, although they may nevertheless be referred to an EN or an SVRA if they try to get services through other channels. Lack of awareness and use is not, however, unique to TTW. In fact, awareness of TTW exceeds that of other SSA work incentives, which is very low among beneficiaries, as is their use of work-related resources.

A third reason for nonparticipation is that a fairly small, but still important, group of beneficiaries who want to work and who know about TTW reported that they were unable to assign their Ticket. The number of such beneficiaries is a small share of all Phase 1 beneficiaries—on the order of 1 percent—but it is approximately the same as the number of participants.

Together, these three factors suggest that although only a small minority of beneficiaries is likely to value TTW services, the program is currently reaching only part of that minority. for example, we estimate that nearly 10 percent of all working-age beneficiaries indicated that they might try to participate in the future.

That interest suggests that the program could expand by reaching out to current nonparticipants. On the other hand, those who say they are interested in participating may not follow through on these plans for a variety of reasons. In fact, research suggests that only a small share of people with disabilities who express an interest in returning to work do so, even when offered extra help. Thus, although there clearly is great potential for participation to increase in the future, it may not increase by the full amount suggested by the survey estimates. Given the preliminary nature of the evidence on nonparticipation and the early stage of TTW development, it would be useful for SSA to look for ways to reach out to nonparticipants in order to determine more accurately how many of them would use TTW services. There is at least some potential for the program to attract a much larger share of the 32 percent of beneficiaries who have work-related goals.

Beneficiaries with work goals and expectations share two primary characteristics: they are under age 55 and have recently been employed. Targeting work-incentive marketing and education efforts to beneficiaries with these characteristics might be an effective way for SSA to reach those most likely to use TTW and other SSA work-incentive programs.

The analyses that support the above findings are presented in the remainder of this chapter. All analyses focus on beneficiaries in Phase 1 states. In particular, we defined TTW participation on the basis of whether a beneficiary assigned a Ticket at some time during 2003, the year following the initial rollout of TTW in those states.1

A. Employment-Related Goals

Based on the 2004 NBS, 43 percent of beneficiaries have employment-related goals as evidenced by the fact that they were working, looking for work, using employment-support services, or reporting concrete employment goals at the time of the interview (Exhibit VII.1). Seen in reverse, however, these results imply that a majority of beneficiaries (57 percent) do not report such goals and are therefore unlikely to have much demand for the employment services provided through TTW. The link between employment goals and TTW participation is illustrated by the fact that 95 percent of the beneficiaries who participate in TTW reported an employment-related goal or said that they had recently engaged in employment-related activities.

The fact that most beneficiaries did not report concrete employment goals is consistent with the nature of the DI and SSI programs and was incorporated into the design of the TTW program (Mashaw and Reno 1996). The DI and SSI programs provide benefits only to people who have gone through a rigorous disability determination process that finds them unable to engage in SGA (for most beneficiaries, this means that they are not expected to be able to earn more than $860 per month under current regulations). Thus, if a large percentage of beneficiaries worked or had concrete work goals, there could possibly be problems with the initial disability determination.

Used services in 2003 for purposes of getting a job or increasing income

3

32

Goals include work/career advancement

32

80

Sees self working for pay in the next five years

30

80

Sees self working and earning enough to stop receiving disability benefits in the next five years

17

53

Any of the above

43

95

Source: 2004 NBS. Sample size = 2,932.

One issue for the long term is whether TTW and other work initiatives will increase the extent to which beneficiaries have work goals and try to achieve them. It is possible that by mailing Tickets and providing other information about employment, SSA could affect the expectations and long-term activities of beneficiaries. Subsequent rounds of the NBS will allow us to track the prevalence of work and work goals among beneficiaries.

B. Awareness of TTW

Demand for TTW services will depend on more than just whether beneficiaries are interested in working. It will depend on whether they know about the program and how to use their Ticket. Absent this awareness, beneficiaries interested in work may try to obtain employment services but will not use their Ticket.

In general, it appears that beneficiaries are not aware of the TTW program. Based on the survey, just 26 percent of the Phase 1 beneficiaries had heard of TTW at the time of the interview even though SSA had mailed all of them a Ticket. If we look only at those who had employment-related goals, just 15 percent of beneficiaries knew about the TTW program. Thus, for 85 percent of beneficiaries, the two factors essential to TTW participation were not present: work goals and knowledge of the program.

While a lack of awareness limits direct demand for TTW services, beneficiaries may still be referred to TTW if they seek employment services. For example, beneficiaries who try to get services from their state’s SVRA may be enrolled in TTW as part of the SVRA intake process even if they did not know about TTW beforehand. Nevertheless, the fact that so many beneficiaries did not seem to know about TTW is likely to limit the extent to which they avail themselves of the expanded choices and flexible services made available through TTW.

To better understand the characteristics of nonparticipants who did report being aware of TTW, we estimated a multivariate (logit) model of the likelihood of being aware of TTW. This model indicates whether specific sociodemographic, programmatic, and health characteristics are statistically associated with awareness, holding all other characteristics constant (Appendix Table C.32). Characteristics such as education and race/ethnicity were statistically significant, as were high benefit levels.2 Relative to those who were unaware of the program, beneficiaries who had heard of TTW were significantly less likely to be white, Hispanic, or Latino and more likely to be black; were more likely to have a high school education or above along with high monthly benefits (more than $1,000 per month); and were less likely to have high non-SSA benefits (more than $500 per month). As discussed in Chapter III, these factors similarly affect TTW participation, so effects on participation might be due, in part, to effects on awareness.

Even when beneficiaries know about the program, their information is often incomplete. In a manner similar to that described in Chapter IV for self-identified TTW participants, the 26 percent of Phase 1 nonparticipants who had heard of TTW were asked a set of questions to gauge their knowledge of key program features (Exhibit VII.2). In general, most nonparticipants were unaware of the basic program features queried. Combining TTW awareness in general with an awareness of specific program features indicates that only 16 percent of beneficiaries were aware that TTW is a program to improve beneficiaries’ ability to work by helping them get training or employment services, paid for by SSA. (Among those who had heard of TTW, 60 percent reported knowing about this basic TTW goal.) Even fewer beneficiaries (11 percent) were aware that participants are free to choose a provider from a network of participating service providers. Still fewer knew that TTW providers are not paid unless the beneficiary goes to work (6 percent) and that medical continuing disability reviews are waived while participating in the program (7 percent).

Lack of awareness and use of Social Security work incentives is not unique to TTW. In fact, compared with many of the SSA work-related programs and incentives, awareness and use of TTW might be considered relatively high (Exhibit VII.3). The rate of TTW awareness was exceeded only by the awareness rate for the DI trial work period. The relatively high level of awareness of TTW among beneficiaries may be attributable to the relatively recent mailing of the Ticket to all Ticket-eligible beneficiaries. Like reported TTW use rates, reported use rates for all SSA work incentives hover around one percent, except for the much higher use rate associated with the trial work period (10 percent), the somewhat higher Section 1619(b) use rate (2 percent), and the extremely low reported use rate for impairment-related work expenses (0.2 percent).

Exhibit VII.2. Knowledge of TTW Program Features by Phase 1 Nonparticipants

TTW Program Feature

Percent of All Beneficiaries Who Knew of Feature

Percent of Beneficiaries Who Knew of Feature Among Those Who Knew of TTW

Helps people with disabilities get training/employment services paid for by SSA to improve their ability to work

16

60

Participants are free to choose a service provider from among a network of service providers in the program

11

41

The service provider is not paid by SSA unless the beneficiary goes to work

6

22

For beneficiaries participating in TTW, SSA will not conduct a medical CDR

Note: Sample size = 1,796 for provisions applicable only to the SSI program; 1,898 for provisions applicable only to the SSDI program; and 7,603 for provisions applicable to both programs.

a Self-report of ever using provision.b Awareness and use rates calculated as a percentage of SSI recipients age 25 and under who began receiving benefits before age 22. Sample size = 440.c Awareness and use rates calculated as a percentage of Phase 1 beneficiaries.

C. Involuntary Nonparticipants

TTW lets providers choose whom they will serve and so raises the possibility that some beneficiaries who want services will not be able to find a provider that will take their Ticket. Although the new TTW payment systems are intended to give providers a financial incentive to serve beneficiaries, the systems also put providers at risk for the costs of services to beneficiaries who do not earn their way off the rolls. For instance, our interviews with providers (Thornton et al. 2006; and Chapters X and XI) indicate that providers screen applicants, particularly with respect to an interest in working at a level that is high enough to reduce cash benefits to zero (and thereby trigger outcome payments to the provider). In addition, the number or service capacity of TTW providers in a beneficiary’s geographic area may be limited relative to the demand for services. Those two factors clearly demonstrate that there is the potential for involuntary nonparticipation among beneficiaries.

We used the NBS data to develop both a narrow and a broad definition of involuntary nonparticipants. The former includes beneficiaries who reported that they attempted to assign a Ticket and were unsuccessful, and the latter includes beneficiaries who reported that they sought information about TTW but did not assign their Ticket. Together, the two definitions probably capture the true involuntary nonparticipation rate because the narrow definition excludes beneficiaries who became discouraged before trying to assign their Ticket, and the broad definition includes beneficiaries who may have made only minimal efforts to get information but decided not to pursue TTW services before contacting any provider. Like the other survey findings reported in this chapter, our findings on involuntary participation reflect beneficiaries living in Phase 1 states who were nonparticipants when they were interviewed in 2004.

In general, we found that there were very few involuntary nonparticipants (Exhibit VII.4, column 1). By the narrow definition, fewer than one percent of all Phase 1 beneficiaries were involuntary participants; that is, they reported being unsuccessful in their attempts to assign their Ticket. By the broader definition, the nonparticipation rate rises to three percent.

The rate of involuntary nonparticipation increases, however, if we look at not just all Phase 1 nonparticipants but at three subgroups made up of progressively fewer beneficiaries with progressively higher probabilities of demanding TTW services:

Nonparticipants who reported being aware of TTW

Nonparticipants who reported being aware of TTW and who have employment-related goals

Nonparticipants with employment-related goals who were aware of and sought information about TTW

a Includes Phase 1 nonparticipants who worked in 2003, were working at interview, looked for work in the past four weeks, indicated that personal goals included work or career advancement, saw themselves working in the next five years, or used services in 2003 in order to find a job or increase income.

Under the narrow definition, involuntary nonparticipation is highest (9 percent) among the smallest and most likely subgroup to demand TTW services (those with employment goals who were aware of the program and sought information about TTW). Under the broader definition, the involuntary nonparticipation rate peaks at 16 percent among the second subgroup, all TTW-aware nonparticipants with employment-related goals.

Examination of the characteristics of involuntary nonparticipants suggests that they differ in several respects from TTW participants. Involuntary nonparticipants were more likely to be age 55 or older, male, married, and African American, and to have the following: less than a high-school level of education, higher-than-average non-SSA benefits, and a household income below the poverty level. Involuntary nonparticipants also appear to be in poorer health than TTW participants because they were more likely to report being in poor or worsening health, and to report multiple ADL and IADL difficulties. In particular, involuntary nonparticipants were much more likely to report difficulties getting around inside and outside the home and performing self-care activities, and among those not working at interview, a much larger share gave poor health as a reason for not working.

Involuntary nonparticipations were, however, similar to TTW participants in that their likelihood of reporting having employment goals and their expectations of working for pay and leaving the rolls in the near future were substantially greater relative to beneficiaries in general, although slightly lower relative to TTW participants. Involuntary nonparticipants were also less likely than TTW participants to be working at interview or to have worked during the previous year, but were more likely to have reported looking for work during the previous four weeks at interview (Appendix Table C.16).

Although the sample of involuntary nonparticipants is small and it may be too soon to draw conclusions, it appears that, despite having similar strong interests in work, involuntary nonparticipants are more likely than TTW participants to have many characteristics that suggest substantial barriers to employment (e.g., poor health, low levels of education, greater reliance on public benefits, poverty) and because of these characteristics, providers may be less willing to serve these individuals. However, these same characteristics might also be associated with a more limited ability to successfully navigate the system in a way that results in Ticket assignment. Only one-third of those who sought information about TTW or tried to participate actually contacted a provider about participation, and even fewer attempted to assign their Ticket. The majority of involuntary nonparticipants never got to the critical point in the process of contacting any providers, suggesting that factors other than provider refusal to accept Tickets—such as an inability to obtain information, an inability to navigate the process, and/or lack of providers in their areas to contact about services—may be dampening participation.

While we estimated that only a very small fraction of beneficiaries (from about 1 to 3 percent) were involuntary nonparticipants during 2003, that fraction is large relative to the participation rate of 0.8 percent for the same period. Thus, it is possible that the number of involuntary nonparticipants in Phase 1 states in 2003, even narrowly defined, was on the same order of magnitude as the number of participants.

D. Expectations of Future Participation in TTW

To assess the possible future demand for TTW services, we examined whether beneficiaries who did not participate in TTW during 2003 expected to participate in the future. Specifically, respondents to the 2004 NBS who resided in Phase 1 states, who had heard of TTW, and who were not participating in the program were asked whether they thought they might try to participate in TTW in the future. Of these respondents, just under 40 percent, or 10 percent of all Phase 1 beneficiaries, answered affirmatively (Exhibit VII.5). The prospects for future participation are higher among the subgroup of TTW-aware nonparticipants who indicated that their goals or expectations included employment: 55 percent of that group indicated that they planned to try to participate in TTW in the future.

A logit model of the likelihood of reporting a willingness to try to participate in TTW in the future indicates that the characteristics of individuals showing such interest differ in several respects from the characteristics of those with no such interest (Appendix Table C.33). The former are significantly more likely to be younger; on the rolls for 13 to 24 months; DI beneficiaries in the 24-month waiting period for Medicare; black; and to have children living with them. They are also significantly less likely to have reported a sensory disorder as a condition causing limitation.

a Includes Phase 1 nonparticipants who worked in 2003, were working at interview, looked for work in past four weeks, indicated that personal goals included work or career advancement, saw themselves working in the next five years, or used services in 2003 in order to find a job or increase income.

As with the TTW awareness, employment goals and expectations are substantially different for those with and those without plans to participate in TTW in the future. Relative to those with no plans to participate in TTW, those indicating plans to try to participate were substantially more likely to report having employment goals and to see themselves working in the next five years (about 70 percent compared with about 25 percent for both employment-related characteristics) (Appendix Table C.17). Among nonparticipants who indicated no plans to participate in TTW in the future, the primary reason given was poor health and/or an inability to work (58 percent).3

The interest expressed in future TTW use suggests that the program is currently reaching only a fraction of those who might eventually participate. Many other reasons, however, may explain why there is no follow-through on reported plans to participate. In addition, research suggests that only a small share of people with disabilities who express plans to return to work do so, even when offered extra help. McMahan (1992) interviewed a sample of Maryland residents with disabilities about their employment status and their desire to go to work, then offered those interested in working an opportunity to be contacted by a job placement service, the Maryland Corporate Partnership (MCP), and to subsequently schedule an appointment. Among those not working but wanting to work, only 12.5 percent reported that they were interested in hearing from MCP and followed through to schedule and keep an appointment for job placement services.

E. Targeting Potential TTW Participants

It is clear that the beneficiaries who are more likely to participate in TTW are those indicating some interest in employment. Two characteristics in particular appear to be highly correlated with TTW participation: having goals that include work or career advancement and seeing oneself as working in the next five years. Over 80 percent of TTW participants had one or both of these characteristics at the time of the interview. In this section, we analyze the subgroup of all beneficiaries with these two characteristics under the assumption that these beneficiaries would be good targets for future SSA, TTW, and other marketing and education efforts related to work incentives.

Among all beneficiaries (all phases), 37 percent, or 3.25 million, indicated that their goals include work or career advancement and/or that they see themselves working in the next five years. To assess which personal characteristics are highly correlated with work goals and expectations, holding other characteristics constant, we estimated a logit model, including as independent variables only characteristics that could be obtained from SSA administrative data (Appendix Table C.34). Several characteristics included in the model are significantly associated with having work goals and expectations, but two in particular are very strongly associated: age and having worked during the previous year while on the disability rolls.4 , 5 All else constant, beneficiaries age 18 to 24 were considerably more likely to report having work goals or expectations. Using the parameters of the logit model and holding other characteristics constant at their mean values, we estimated that 71 percent of those age 18 to 24 have work goals and expectations, compared with 21 percent of those age 55 and older (Exhibit VII.6). Although work expectations decline with age, those age 25 to 39 and those age 40 to 54 were still significantly more likely to report having work goals or expectations relative to beneficiaries age 55 and older. Other characteristics held constant, an estimated 81 percent of those who had worked at some point during the previous year indicated having work goals or expectations, relative to 29 percent of those who had not worked during the previous year.

Exhibit VII.6. Simulated Probabilities of Having Work Goals, by Selected Characteristics

Characteristics

Likelihood of Having Work Goals
or Expectations

Age

18–24

0.71

25–39

0.54

40–54

0.40

55 and over

0.21

Worked During Previous Year

0.81

Did Not Work During Previous Year

0.29

Source: Authors’ calculations based on a logit model (Appendix Table C.34) estimated with data from the 2004 NBS.

Note: Other characteristics are held constant at sample means.

These findings imply that SSA could reach the largest number of beneficiaries willing to work by targeting TTW marketing and education efforts to younger beneficiaries and those who worked while on the rolls during the previous year. For example, based on the estimates shown in Exhibit VII.7, 91 percent of those aged 18 to 39 who also worked in the previous year (subgroup 2B) are likely to participate in TTW in that they have goals that include work or career advancement and/or they see themselves working in the next five years. This is a relatively small group, however, in that they make up only 12 percent of those who are likely to participate in TTW (i.e., those with work goals and expectations). However, those aged 18-39 who also worked in the previous year number only about 0.41 million, so a campaign targeting them could be relatively inexpensive. Looking at the other subgroups we see that SSA could get the most efficiency out of an information campaign if it were to focus only on beneficiaries under the age of 50 and/or beneficiaries who worked during the previous year (subgroup 3C). If SSA were to target only this group, 75 percent of all beneficiaries with work goals and expectations would be reached. However, the campaign would need to focus on just over half of the total beneficiary population (4.39 million), making it far less costly than a general campaign targeting all beneficiaries.

In addition to age and recent work activity, time on the rolls is highly correlated with having work goals and expectations. The logit model indicates that those on the rolls for more than one year but less than five years are most likely to report having work goals and expectations (about 10 to 15 percentage points more likely, all else constant). These findings might suggest that the timing of follow-up promotions for TTW and work incentives should occur about one year after beneficiaries have come on the rolls and continue up until about five years after that point, when, all else constant, beneficiaries might be most responsive to the information.

Exhibit VII.7. Beneficiaries Most Likely to Participate in TTW and Percent of This Population in Selected Subgroups

Age and 1–5 years on disability rolls, or worked during previous yearc

5A

18-24 and on rolls 1–5 years or worked during previous year

1.22

82

31

2.7

5B

18-39 and on rolls 1–5 years OR worked during previous year

1.61

76

38

2.3

5C

18-49 and on rolls 1–5 years OR worked during previous year

2.15

68

45

1.8

6

All beneficiaries

8.79

37

100

0.8

Source: 2004 NBS. Sample size = 7,603.

a Those likely to participate in TTW are defined as those with goals that include work or career advancement and/or who see themselves working in the next five years.b Phase 1 TTW participation rates as of June 2003, based on survey data. c The “worked during previous year” criteria includes only respondents who reported that they worked during 2003 and who had been on disability rolls for more than 12 months at the time of interview in 2004.

The above discussion is not intended to imply that all beneficiaries should not have equal access to all work-related information and resources provided by SSA. Rather, it is intended to illustrate that a few observable characteristics are highly correlated with having work goals and expectations. Knowing what these characteristics are might be useful for purposes of tailoring future SSA work-incentive marketing and information efforts to improve their effectiveness.

The analysis in this chapter has focused on nonparticipants. The next chapter presents findings on the activities of four other beneficiary groups, defined in the Ticket Act as the “hard-to-serve” groups.

1 Our sample includes a small number of beneficiaries who were not Ticket eligible at the time of interview. Among the Phase 1 nonparticipants analyzed in this chapter, 0.5 percent had not been mailed a Ticket at the time they were interviewed. For another 3.5 percent of Phase 1 nonparticipants, Ticket eligibility at interview could not be determined because the Ticket mail date information was missing from the administrative data. (back)

2 One of the self-reported health conditions causing limitation (other diseases of the nervous system) was statistically significant and negatively associated with awareness. No other health conditions or health-related variables were significant. (back)

3 Other reasons for indicating no plans to participate in TTW in the future include: not knowing about the program (10 percent); were working or in school (9 percent); and having no desire to participate (9 percent). (back)

4 We defined work during the previous year based on beneficiary self-reports. Those who had been on the rolls for one year or less at the time of interview and who worked in the previous year were not assigned a value of 1 for this measure because we wanted to reduce the chances of including individuals who were working during 2003 prior to qualifying for disability benefits. (back)

5 Other characteristics significantly associated with having work goals or expectations include: having a primary insurance amount equal to 1200 or greater (negative); being on the rolls from two to five years (positive); being African American or being of Hispanic or Latino ethnicity (positive); and having a high-school level of education or higher (positive). See Appendix Table C.34. (back)